HomeMy WebLinkAboutC2017-158 - 4/18/2017 - Approved USC .
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,,coRp B0.0 SERVICE AGREEMENT NO. 984
Y852
EMERGENCY MEDICAL SERVICES ("EMS..") BILLING AND COLLECTION SERVICES
- THIS .EMS Billing and Collection Services Agreement.. ("Agreement) is •
entered into by and: between the City of Corpus Christi; a Texas home-rule
municipal corporation ("City") and Advanced: Data Processing, Inc., a
subsidiary of Intermedix Corporation ("Contractor"), effective upon execution
by the City Manager or the City Manager's designee ("City Manager").)•
WHEREAS, Contractor has bid to provide EMS Billing and Collection Services
in response. to Request for Bid/Proposal No. 984 ("RFB/RFP''), which RFB/RFP
• includes the required scope of work and all specificationsand which RFB/RFP
and the Contractor's bid or proposal response, as applicable, are incorporated
by reference in this Agreement as Exhibits 1, and 2, respectively, as if each were
fully set out here in its entirety.
NOW, THEREFORE, City and Contractor agreeas follows:
1. Scope. Contractor Will .provide EMS Billing . and Collection_ Services
("Services") in accordance:with the attached:Scope of Wor:k,:as shown in
Attachment A, the content of which isincorporated by reference.:into:this
Agreement as if fully set out here in its. entirety, and in .accordance with
Exhibit 2.
2. Term. .This Agreement;is for 36 months, with performance commencing
upon the date of issuance of a notice to proceed from the Contract.
Administrator'or Purchasing .Division. This Agreement includes an option to
extend the term for up to two additional 12-month periods ("Optio,n
Period"), provided, the parties do so prior to expiration of the original term
or the then-current Option :Period. The decision to exercise:the option to
extend the term of this Agreement is, at all times, within the sole discretion
of. the City and is conditioned upon:the prior written agreement of the
Contractor and the City Manager.
3. Compensation and Payment. As.consideration for the services performed
by the Contractor hereunder, City shall pay Contractor 4.96% per month of
net collections from billing for emergency medical services. City shall pay
Contractor 4.96% per month of net collections from Texas Ambulance
Supplemental Payment Program. City shall pay Contractor 6.00% per month
of net collections from collection of delinquent accounts: up to 120 days :
2017-158 Page 1 of 8
4/18/17 -
M2017-055
Advanced Data Processing Inc.
INDEXED
old. City shall pay Contractor 20.00% per month of net collections from
collection of delinquent accounts past 120 days old. Net collections shall
be defined as the total sum of all monies collected by Contractor for all
EMS rendered by City including delinquent accounts, less amounts
refunded or credited to patient or third party payer as a result of
overpayments, erroneous payments or bad checks. On a monthly basis,
Contractor shall submit an invoice listing the total number of paid claims.
All pricing must be in accordance with the attached Bid/Pricing Schedule,
as shown in Attachment B, the content of which is incorporated by
reference into this Agreement as if fully set out here in its entirety. Payment
and compensation for the initial term of this agreement shall not exceed
$9,351,660.00.
4. Contract Administrator. The Contract Administrator designated by the City
is responsible for approval of all phases of performance and operations
under this Agreement, including deductions for non-performance and
authorizations for payment. The City's Contract Administrator for this
Agreement is as follows:
Assistant Fire Chief Kenneth Erben
Corpus Christi Fire Department
(361) 826-3931
KennethE@cctexas.com
5. Insurance; Bonds.
(A) Before performance can begin under this Agreement, the Contractor
must deliver a certificate of insurance ("COI"), as proof of the required
insurance coverages, to the City's Risk Manager and the Contract
Administrator. Additionally, the COI must state that the City will be given at
least 30 days' advance written notice of cancellation, material change in
coverage, or intent not to renew any of the policies. The City must be
named as an additional insured. The City Attorney must be given copies of
all insurance policies within 10 days of the City Manager's written request.
Insurance requirements are as stated in Attachment C, the content of
which is incorporated by reference into this Agreement as if fully set out
here in its entirety.
(B) In the event a payment bond, a performance bond, or both, are
required of the Contractor to be provided to the City under this Agreement
before performance can commence, the terms, conditions, and amounts
required in the bonds and appropriate surety information are as included in
the RFB/RFP or as may be added to Attachment C, and such content is
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incorporated here in this Agreement by reference as if each bond's terms,
conditions, and amounts were fully set out here in its entirety.
6. Purchase Release Order. For multiple-release purchases of Services to be
provided by the Contractor over a period of time, the City will exercise its
right to specify time, place and quantity of Services to be delivered in the
following manner: any City department or division may send to Contractor
a purchase release order signed by an authorized agent of the department
or division. The purchase release order must refer to this Agreement, and
Services will not be rendered until the Contractor receives the signed
purchase release order.
7. Inspection and Acceptance. Any Services that are provided but not
accepted by the City must be corrected or re-worked immediately at no
charge to the City. If immediate correction or re-working at no charge
cannot be made by the Contractor, a replacement service may be
procured by the City on the open market and any costs incurred, including
additional costs over the item's bid/proposal price, must be paid by the
Contractor within 30 days of receipt of City's invoice.
8. Warranty. The Contractor warrants that all products supplied under this
Agreement are new, quality items that are free from defects, fit for their
intended purpose, and of good material and workmanship. The Contractor
warrants that it has clear title to the products and that the products are free
of liens or encumbrances. In addition, the products purchased under this
Agreement shall be warranted by the Contractor or, if indicated in
Attachment D by the manufacturer, for the period stated in Attachment D.
Attachment D is attached to this Agreement and is incorporated by
reference into this Agreement as if fully set out here in its entirety.
9. Quality/Quantity Adjustments. Any Service quantities indicated on the
Bid/Pricing Schedule are estimates only and do not obligate the City to
order or accept more than the City's actual requirements nor do the
estimates restrict the City from ordering less than its actual needs during the
term of the Agreement and including any Option Period. Substitutions and
deviations from the City's product requirements or specifications are
prohibited without the prior written approval of the Contract Administrator.
10. Non-Appropriation. The continuation of this Agreement after the close of
any fiscal year of the City, which fiscal year ends on September 30th
annually, is subject to appropriations and budget approval specifically
covering this Agreement as an expenditure in said budget, and it is within
the sole discretion of the City's City Council to determine whether or not to
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fund this Agreement. The City does not represent that this budget item will
be adopted, as said determination is within the City Council's sole discretion
when adopting each budget.
11. Independent Contractor. Contractor will perform the work required by this
Agreement as an independent contractor and will furnish such Services in
its own manner and method, and under no circumstances or conditions will
any agent, servant or employee of the Contractor be considered an
employee of the City.
12. Subcontractors. Contractor may use subcontractors in connection with the
work performed under this Agreement. When using subcontractors,
however, the Contractor must obtain prior written approval from the
Contract Administrator if the subcontractors were not named at the time of
bid or proposal, as applicable. In using subcontractors, the Contractor is
responsible for all their acts and omissions to the same extent as if the
subcontractor and its employees were employees of the Contractor. All
requirements set forth as part of this Agreement, including the necessity of
providing a COI in advance to the City, are applicable to all
subcontractors and their employees to the same extent as if the Contractor
and its employees had performed the work.
13. Amendments. This Agreement may be amended or modified only by
written change order signed by both parties. Change orders may be used
to modify quantities as deemed necessary by the City.
14. Waiver. No waiver by either party of any breach of any term or condition of
this Agreement waives any subsequent breach of the same.
15. Taxes. The Contractor covenants to pay payroll taxes, Medicare taxes,
FICA taxes, unemployment taxes and all other related taxes. Upon request,
the City Manager shall be provided proof of payment of these taxes within
15 days of such request.
16. Notice. Any notice required under this Agreement must be given by fax,
hand delivery, or certified mail, postage prepaid, and is deemed received
on the day faxed or hand-delivered or on the third day after postmark if
sent by certified mail. Notice must be sent as follows:
IF TO CITY:
City of Corpus Christi
Attn: Kenneth Erben
Assistant Fire Chief- Operations
Page 4 of 8
2406 Leopard St., Suite 200, Corpus Christi, TX 78408
(361) 826-4223
IF TO CONTRACTOR:
Advanced Data Processing, Inc., a subsidiary of Intermedix
Corporation
Attn: Michael Silk
Title: Senior Director of Business Development
Address: 78 Regency Parkway, Mansfield, TX 76063
Fax: (954) 308-8725
17. CONTRACTOR AGREES TO INDEMNIFY, HOLD HARMLESS AND
DEFEND THE CITY OF CORPUS CHRISTI AND ITS OFFICERS,
EMPLOYEES AND AGENTS ("INDEMNITEES") FROM AND AGAINST
ANY AND ALL LIABILITY, LOSS, CLAIMS, DEMANDS, SUITS AND
CAUSES OF ACTION OF ANY NATURE WHATSOEVER ON ACCOUNT
OF PERSONAL INJURIES (INCLUDING DEATH AND WORKERS'
COMPENSATION CLAIMS), PROPERTY LOSS OR DAMAGE, OR ANY
OTHER KIND OF INJURY, LOSS, OR DAMAGE, INCLUDING ALL
EXPENSES OF LITIGATION, COURT COSTS, ATTORNEYS' FEES AND
EXPERT WITNESS FEES WHICH ARISE OR ARE CLAIMED TO ARISE OUT
OF OR IN CONNECTION WITH THIS AGREEEMENT OR THE
PERFORMANCE OF THIS AGREEMENT, REGARDLESS OF WHETHER
THE INJURIES, DEATH OR DAMAGES ARE CAUSED OR ARE CLAIMED
TO BE CAUSED BY THE CONCURRENT OR CONTRIBUTORY
NEGLIGENCE OF INDEMNITEES, BUT NOT IF BY THE SOLE
NEGLIGENCE OF INDEMNITEES UNMIXED WITH THE FAULT OF ANY
OTHER PERSON. CONTRACTOR, MUST, AT ITS OWN EXPENSE,
INVESTIGATE ALL CLAIMS AND DEMANDS, ATTEND TO THEIR
SETTLEMENT OR OTHER DISPOSITION, DEFEND ALL ACTIONS BASED
THEREON WITH COUNSEL SATISFACTORY TO THE CITY ATTORNEY,
AND PAY ALL CHARGES OF ATTORNEYS AND ALL OTHER COSTS
AND EXPENSES OF ANY KIND ARISING FROM ANY SAID LIABILITY,
DAMAGE, LOSS, CLAIMS, DEMANDS, SUITS, OR ACTIONS. THE
INDEMNIFICATION OBLIGATIONS OF CONTRACTOR UNDER THIS
SECTION SHALL SURVIVE THE EXPIRATION OR EARLIER
TERMINATION OF THIS AGREEMENT.
18. Termination.
Page 5 of 8
(A) The City Manager may terminate this Agreement for Contractor's
failure to perform the work specified in this Agreement or to keep any
required insurance policies in force during the entire term of this
Agreement. The Contract Administrator must give the Contractor written
notice of the breach and set out a reasonable opportunity to cure. If the
Contractor has not cured within the cure period, the City Manager may
terminate this Agreement immediately thereafter.
(B) Alternatively, the City Manager may terminate this Agreement for
convenience upon 30 days advance written notice to the Contractor. The
City Manager may also terminate this Agreement upon 24 hours written
notice to the Contractor for failure to pay or provide proof of payment of
taxes as set out in this Agreement.
19. Assignment. No assignment of this Agreement by the Contractor, or of any
right or interest contained herein, is effective unless the City Manager first
gives written consent to such assignment. The performance of this
Agreement by the Contractor is of the essence of this Agreement, and the
City Manager's right to withhold consent to such assignment is within the
sole discretion of the City Manager on any ground whatsoever.
20. Severability. Each provision of this Agreement is considered to be
severable and, if, for any reason, any provision or part of this Agreement is
determined to be invalid and contrary to applicable law, such invalidity
shall not impair the operation of nor affect those portions of this Agreement
that are valid, but this Agreement shall be construed and enforced in all
respects as if the invalid or unenforceable provision or part had been
omitted.
21. Order of Precedence. In the event of any conflicts or inconsistencies
between this Agreement, its attachments, and exhibits, such conflicts and
inconsistencies will be resolved by reference to the documents in the
following order of priority:
A. this Agreement and its attachments
B. the bid solicitation document, including addenda (Exhibit 1)
C. the Contractor's bid response (Exhibit 2)
22. Certificate of Interested Parties. Contractor agrees to comply with Texas
Government Code Section 2252.908, as it may be amended, and to
complete Form 1295 "Certificate of Interested Parties" as part of this
Agreement.
Page 6 of 8
23. Governing Law. This Agreement is subject to all federal, State, and local
laws, rules, and regulations. The applicable law for any legal disputes
arising out of this Agreement is the law of the State of Texas, and such form
and venue for such disputes is the appropriate district, county, or justice
court in and for Nueces County, Texas.
24. Business Associate Agreement. The Contractor acknowledges and agrees
that as relates to use and disclosure of Protected Health Information under
the Health Insurance Portability and Accountability Act of 1996, as
amended, they are subject to the terms of the Business Associate
Agreement set forth in Attachment E.
25. Collections. Contractor's collection efforts must be conducted through
proper and lawful means without threats, intimidation, or harassment of the
debtor in full compliance with the Fair Debt Collection Practices Act
(FDCPA) and any other applicable federal or state law.
26. Non-Discrimination. Contractor shall not discriminate on the basis of sex,
race, creed, color, national origin or disability in regard to collection efforts
and employment decisions.
27. Entire Agreement. This Agreement constitutes the entire agreement
between the parties concerning the subject matter of this Agreement and
supersedes all prior negotiations, arrangements, agreements and
understandings, either oral or written, between the parties.
(SIGNATURE PAGE FOLLOWS)
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CONTRACTOR
Signature: -- „ J
Printed Nam/ Ken Cooke
Title: President and COO
Date: April 5, 2017
CITY OF CORPUS CHRISTI
Signature: - _ ;
Printed Name: lti��.. �..0 ,, Z
Title: Pr` - � .� mac.- '�,--_
Date: H - ,t,/-c -- ( 7
REBECCA HUERTA
CITY SECRETARY
Attached and Incorporated by Reference:
Attachment A: Scope of Work
Attachment B: Bid/Pricing Schedule
Attachment C: Insurance/Bond Requirements
Attachment D: Warranty Requirements
Attachment E: Business Associate Agreement
Incorporated by Reference Only:
Exhibit 1: RFB/RFP No. 984
Exhibit 2: Contractor's Bid/Proposal Response
Approved as to legal form:
73
7 Page 8 of 8
Buck Brice 1 n ��J
0 6C
Assistant City Attorney f SCJ AUT ORILt►
For City Attorney
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4Fr,RFn kov•
Attachment A: Scope of Work
1. Scope of Work
1 . The Contractor shall provide billing of accounts receivable using the
necessary billing forms for various third party payors in the following financial
class:
A. Self-pay
B. Commercial Insurance
C.Blue Cross, Blue Shield
D.Medicare
E. Medicaid
F. Worker's Compensation
G. Personal Injury Protection (Auto Insurance)
2. The Contractor shall code each new receivable in one of the financial classes
from the list above.
3. The Contractor shall prepare and mail an initial insurance bill to the appropriate
third party payor within 10 working days from the date on which the receivable
is made available for billing.
4. The Contractor shall be able to export the patient report data from the current
Electric Patient Care Report (ePCR) provider (Emergidata [RescueMedic] of
Richardson, TX) and pull that data into the billing software for accurate billing.
If the ePCR system is changed during the contract term, the Contractor shall
be responsible for all necessary interface components (hardware and
software) and technical support for receiving and translating transport records
from the new ePCR system. The contractor shall also insure that any ePCR
provider chosen shall interface with the current CAD system (Intergraph).
5. The Contractor shall obtain any missing data necessary for billing through
available databases, telephone queries from either the receiving hospital or
from the patient, using mail only if telephone contact numbers are unavailable.
6. The Contractor shall send a written follow up request for payment to the
appropriate third party within 45 days of the initial billing if the receivable
remains outstanding.
7. The Contractor shall be cognizant of and abide by the billing requirements
dictated for Medicare, Medicaid and Worker's Compensation patients. The
Contractor shall adhere to the contractual restrictions inherent in these billings
and must hold the City of Corpus Christi harmless for any billing errors. The
Contractor shall also be cognizant of and abide by any other normal billing
practices in the industry in accordance with all applicable State and Federal
Page 1 of 8
laws per the Texas Debt Collection Act and the Federal Fair Debt Collection
Practices Act.
8. The ePCR provider shall ensure that all data is gathered in electronic format
and report to the designated State of Texas registry on a monthly basis, all
information as necessary to keep the City in compliance with EMS and trauma
registries. In addition, the EMS Billing Contractor in conjunction with the ePCR
vendor shall submit a report to the Contract Administrator detailing the registry
submitted on a monthly basis. (See Texas Administrative Code, Title 25, Part 1 ,
Ch. 103, 103.1 - 103.8)
9. The Contractor must deposit payment within 24 hours of receipt. The City
requires that the Contractor use a lockbox for daily payment processing with
deposits process to the City's depository account. The Contractor will receive
notifications of ACH (automated clearing house) electronic deposit and will
post these deposits no later than the next business day after the date received.
The contractor must email daily deposit reports as directed by the City
Treasure.
2. Ambulance Rates
Ambulance rates for emergency medical services are charged as follows:
Fee Per
Service or Item Service
or Item
(1) EMS 911 base rate - Transport $800.00
(2) EMS 911 base rate - No transport 125.00
(3) Adenosine 50.00
(4) Albuterol 5.00
(5) Atropine 5.00
(6) Bandage/bandaging 9.00
(7) Bedpan/urinal 2.00
(8) Benadryl 5.00
(9) Bite stick 2.00
(10) Blanket (disposable) 7.00
(1 1) Burn sheet 8.00
(12) Bag Valve Mask 20.00
(13) Capnography (Capnoline) 90.00
(14) Cervical collar 21 .00
Page 2 of 8
(15) Cold pack 3.00 i
(16) �_� ����_ Collection bag/basin _ � 2.00
(17) Combi/king - tube airway � 90.00
_._.�_.._-���� �-_�_-���' Defibrillationpads __ �� _ 40.00
(18) I ;
(19) Dextrose ______.._._�.____i__.__.__10.00 __
(20) IGlucose test strip 2.00
EKG, non 12-lead I 50.00
_.___(22) �.!_._________.._...__._._�.__� .EKG,'12 lead ._..___.�__.___...__._._,__�..�_! .µ. 100.00
(23) i _ �� Endotracheal tube i 15.00 i
(24) 1 �� _ Endotracheal tube holder 5.00
(25) Epinephrine (1:1000) j 5.00
(26) 1 Epinephrine (1 :10000) � 9.00
1 (27) �1 �� !� - Glucose paste � 5.00
1 (28) Head immobilizer 10.00 I
(29) .._____._.__._._.._....._.._._.._.�. Hot pack .._._ _ _. ._._..�..��_ _.___._._ 2.00
j (30) Intubation �� 75.00 _r
(31) ; Intraosseous infusion 150.00 I
(32) _ Intravenous (IV) pad _ 15.00 j
jM (33) ; Intravenous (IV) infusion _ 35.00 i
(34)_ � _ Intropine _ 10.00 1
I (35) i_ Lasix •
_ 10.00
(36) Lidocaine 2% j 5.00
(37) 1 Lidocaine drip ( 20.00 1
i
(38) I Liquid acetaminophen • 5.00
{ (39) ___ Morphine 25.00
�
(40) , �-�� ��� Narcan y �_ _ � 15.00
(41) __.. _ __Nebulizer m ask �_� 5.00
1--(42) 'M Nitrospray le 5.00
(43) Normal Saline 1000 ml ��� 1 20.00 f
j (44) 1
1 Normal Saline 500 ml 15.00 j
{ (45) Norma Saline 250 ml 10.00 J
(46) Normal Saline 100 ml I 5.00
I__-(47) i .___-___.__ ___________.____._�__ Normodyne I
__ _ _ __._ _ _ ____________ ____. __________.___. __________ _ _.10.00_ I
Page 3 of 8
(48) I Obstetrical kit U.00 I
(49) I Oral airway y 3.00 ;
I (50) j a Oxygen �� 35.00 I
(51) i Oxygen mask 10.00 1
(52) 1 Pitocin 5.00 j
(53) ; Pulse oximetry I 50.00
(54) Sodiumbicarbonate 5.
ZIiII1IiiiiI1_1Ioo
(55) Solu-medrol 1 5.00
(56) 1 Spinal immobilization ; 35.00 j
(57) j`____�_____ _�____. S pl i nt _a._,..__.___�w.__ __ �� 30.00
(58) ! Suction 10.00
(59) '. ._____�__�________ __________Thiamine �_– _--____.______..__�. _____i__�___ 7.00 �
{P—(60)_�,�u_..___ __. -- ____ Valium � ~- �__- � 25.00 _
(b) Supplementary charges:
(1) Providing a mileage charge of fifteen dollars ($15.00) per mile from patient pick-
up point to the hospital.
(2) Providing a fee for responding to a medical alarm which is a malfunction, no one
at home, no one injured, sixty dollars ($60.00).
(3) Providing a charge of one hundred twenty-five dollars ($125.00) for emergency
medical services provided to non-residents.
(4) The city manager is authorized to establish charges, not to exceed the
reasonable cost of providing the service, for other supplementary services such
as providing standby equipment and crews at special events and attending
training courses.
(5) Providing a charge of forty-five dollars ($45.00) for additional personnel when
needed to provide patient care during transport.
(c) Review of charges. The Corpus Christi EMS ambulance service rates shall be reviewed
as needed to determine the need for adjustments.
•
Page 4 of 8
3. Billing and Collection Information
Billing and Collection information for FY 14- 15 is as follows:
Charges
Charges $22,998,866.50
Adjustments $ 7,628,131 .59
Net Charges $15,370,734.59
Payments
Medicare Payments $2,608,786.93
Medicaid Payments $1,262,030.15
Insurance Payments $1,631,633.46
Private Payments $ 177,124.02
Total Payments $5,679,574.56
Charges by Service Level - ALS
ALS Service Charges $12,144,800.00
Mileage $ 1,033,720.50
Supplies $ 2,269,597.00
Charges by Service Level -BLS
BLS Service Charges $ 6,496,000.00
Mileage $ 515,481 .00
Supplies $ 539,268.00
Page 5 of 8
4. Delinquent Accounts
1 . The Contractor must provide a procedure for collection of delinquent
accounts, for those accounts unpaid for 120 days after the first billing. The
Contractor must establish a systematic collection procedure including
telephone, mail and/or personal contact to collect delinquent accounts. The
Contractor must describe the collection procedure in a narrative and include
in the narrative the collection methodology, expected collection rates and
past history in collecting delinquent accounts.
2. The Contractor will assist the Contract Administrator in establishing the amounts
for allowance to bad debt and the amount necessary for the Medicare and
Medicaid contractual allowances in order that reserves may be properly
stated on the financial statement.
3. The Contractor may authorize self-pay patients to liquidate any outstanding
balance by installment method. The minimum payment on the installments
shall be $35.00 per month or 1/12 of the original outstanding balance,
whichever is greater. No interest may be charged.
4. Contractor must follow Title 5, Chapter 392 of the Texas Finance Code (Debt
Collection Act) on all contacts on delinquent accounts.
6. Supplemental Billing
The City requests that the contractor provide the following services with regard to
participation in the Texas Ambulance Supplemental Payment Program (TASPP) for
consideration. The City has received approval for Supplemental Billing effective
November 22, 2016. These services should be provided separately from the
required services outlined above.
1 . Provide supplemental payment recovery assistance services to assist the City in
participation in the TASPP which responsibilities to include:
A. Advising and assisting the City will annual enrollment in TASPP
B. Managing program applications and required cost reports for the City in
accordance with the TASPP
C. Managing the TASPP pre-cost report submitted process for the City which
may also include: developing and submitting the provider approval
materials to the Texas Health and Human Services Commission (HHSC) on
behalf of the City, receiving the provider approval from HHSC for the City's
participation in the TASPP and developing and submitting the Cost
Allocation Model and Report on behalf of the City for review as part of the
TASPP
D. Changing and finalizing the Cost Allocation Model during HHSC's review of
the Cost Allocation Model and Report to meet HHSC's requirements
E. Preparing and submitting HHSC Ambulance Services Cost Report on an
annual basis as required by TASPP
F. Assisting the City with submitting other annual reports as required by the
TASPP
G. Ensuring that cost report preparer(s) engaged on behalf of the City by the
vendor are certified in accordance with all applicable rules, laws and
regulations
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H. Ensuring that it utilizes separatestaff for billing and :cost report preparation
services provided to-the Ciy
7. Reports
At a minimum;: the following reports shall be provided on-:a..monthly basis in
electronic (Excel) format: ..
1. Amount billed by patient
2. Amount collected b.. patientan'
Yby typeo
payee
3. Accounts Receivable Summary
4. Accounts Receivable:Aging Report.
5. - Vendor performance analysis report detailing billing, collection, adjustments. ..
with dollar amounts and quantities as well:as collection rates:. Two collection
rates will be calculated, one rate including adjustments and one:rate without
: adjustments
6. Non-transport Summary:Report
7. Transport Reconciliation Report
8. Report of Collections
9. Collections:/ Refund Summa
10. Report:of Revenue Adjustments
11. Bad Deb Write Off.& Government Non-Allowable-Detail
12. •Fiscal Year. Monthly Net Collection Comparison .
13. ALS-BLS Service Mix
14. Other reports as requested by the ContractAdm:inistrator
8. Hardware and:Software
1. The Contractor shall initially replace all 18 laptops: every three years to :include
revised software programs, licenses :and hardware. Costs of laptops=will be
factored in the percentage of the billing.
2.:The .Contractor shall :obtain at its.costs..the EMS data .collection software: and
:related licenses for::. all ambulance units, as selected by the City EMS
Department: .
3. The Contractor Must:be able to switch ePCR vendors to interface to -e City's
existing ePCR software in order to receive patient data electronically should the
City decide to keep current ePCR provider.
Model specifications:.
CF-20A51E4Uhri
Win10 Pro Intel Core m5-6Y57110GHz;vPro,10,1"WUXGA 10-pt Gloved Multi Touch,,8GB,256GB SSD,Intel WiFi a/b/g/n/ae,TPM,Bluetooth,
Dual Pass(Chi,WAN/Ch2:WWAN),2nd USB,Contactless Smartcard/NFC,4G LTE Multi:Carrier jEM7355),Webcam,8MP Cam,Bridge Battery,
Emissive Backlit Keyboard,Toughbook Preferred
For each:machine, in;addition to specs above, add:
-secondary battery (CF-VZSUOQW)
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-screen protectors (CV-VPF31 U),
-AC adapters 65W (CF-AA6413CM)
-40 extra styluses and tethers for CCFD to keep as in house inventory (CF-
VNP022U & CF-VNTOO2U)
9. Training
The Contractor shall provide annually, continuing education in medical
documentation of ambulance transports to all ambulance paramedics.
Page 8 of 8
Attachment B: Bid/Pricing Schedule •
QS C
�� CITY OF CORPUS CHRISTI
� .... A iPricing Form
• . PURCHASING DIVISION
CORPowp,o. REP No: 984
1852
EMS Billing and Collection Services
PAGE 1 OF 2
DATE:
February 10, 2017
Advanced Data Processing, Inc., a subsidiary of.
PROPOSERIntermedin Corporation p THOR ED SIGNATURE
en Cooke, President and Chief Operating Officer
1. Refer to"Instructions to Proposers" and Cont act:Terms and:Conditions before completing
proposal. .
2. Quote your best price for each item.
3. In submitting this proposal, Proposer certifies that;
a. the prices in this proposal have been arrived at independently, without consultation,
communication,-or agreement with any other Proposer or competitor, for the purpose of.
restricting competition with regard to rices,
.
b. Proposer is.an Equal Opportunity Employer; and the Disclosure:of Interest information
on file,with City's purchasing office, pursuant to the Code of Ordinances; is current and
:true::.
c. Proposer has operated continuously for minimum of 3 years as an established firm in
providing EMS Billing and Collection Services.
d: Proposer does not have any outstanding regulatory issues nor has:the Proposer been
involved in any lawsuits during the last 5 years that may materially affect its ability to
provide the services described herein.
e. Proposer must not have any outstanding regulatory issues nor has the Proposer had any
regulatory issues during the last 5 years that may materially affect its ability to provide the
services described herein:
f. Proposer must notbe currently involved in litigation with the City nor has the Proposer
been involved in litigation with the City during the-last5 years.
g. Proposer has incorporated any changes issue through Addenda to the RFP in this
pricing.
UNIT TOTAL
ITEM. DESCRIPTION QTY UNIT PRICE PRICE .
1.0 Percentage of collections charged for $15,370,734 % 4.96% $762,388
billing:of ambulance bills.(net charges
after'adjustments)
2.0 Percentage of collections charged for
collection of current outstanding
receivables at time of award:
a. Up to 120 days old $2,010;6:95 % 6.00% $120,641
b.. Past 120 days old $8,719,345
20.00%
$1,743,869.
1
Page of 2
UNIT TOTAL
ITEM _ DESCRIPTION : QTY UNIT PRICE PRICE
3.0:. TASPP Services=: $9,885,523
Percentage of collections from state 4.96% : $490,322
TOTAL $3,117,220
Page 2 f2. o ..
Attachment C: Insurance/Bond Requirements
INSURANCE REQUIREMENTS
CONTRACTOR'S LIABILITY INSURANCE
A. Contractor must not commence work under this contract until all insurance required has
been obtained and such insurance has been approved by the City. Contractor must
not allow any subcontractor, to commence work until all similar insurance required of
any subcontractor has been obtained.
B. Contractor must furnish to the City's Risk Manager and Contract Administrator one (1)
copy of Certificates of Insurance with applicable policy endorsements showing the
following minimum coverage by an insurance company(s) acceptable to the City's Risk
Manager. The City must be listed as an additional insured on the General liability by
endorsement, and a waiver of subrogation endorsement is required on GL.
Endorsements must be provided with Certificate of Insurance. Project name and/or
number must be listed in Description Box of Certificate of Insurance.
TYPE OF INSURANCE MINIMUM INSURANCE COVERAGE
30-day advance written notice of Bodily Injury and Property Damage
cancellation, non-renewal, material Per occurrence - aggregate
change or termination required on all
certificates and policies.
COMMERCIAL GENERAL LIABILITY $1,000,000 Per Occurrence
including: $2,000,000 Aggregate
1. Commercial Broad Form
2. Premises- Operations
3. Products/Completed
Operations
4. Contractual Liability
5. Independent Contractors
6. Personal Injury- Advertising Injury
ERRORS AND OMMISSIONS $1,000,000 Per Occurrence
C. In the event of accidents of any kind related to this contract, Contractor must furnish
the Risk Manager with copies of all reports of any accidents' within 10 days of the
accident.
II. ADDITIONAL REQUIREMENTS
Page 1 of 3
A. Applicable for paid employees, Contractor must obtain workers' compensation
coverage through a licensed insurance company. The coverage must be written on a
policy and endorsements approved by the Texas Department of Insurance. The
workers' compensation coverage provided must be in statutory amounts according to
the Texas Department of Insurance, Division of Workers' Compensation. An All States
Endorsement shall be required if Contractor is not domiciled in the State of Texas.
B. Contractor shall obtain and maintain in full force and effect for the duration of this
Contract, and any extension hereof, at Contractor's sole expense, insurance coverage
written on an occurrence basis by companies authorized and admitted to do business
in the State of Texas and with an A.M. Best's rating of no less than A- VII.
C. Contractor shall be required to submit renewal certificates of insurance throughout the
term of this contract and any extensions within 10 days of the policy expiration dates.
All notices under this Exhibit shall be given to City at the following address:
City of Corpus Christi
Attn: Risk Manager
P.O. Box 9277
Corpus Christi, TX 78469-9277
D. Contractor agrees that, with respect to the above required insurance, all insurance
policies are to contain or be endorsed to contain the following required provisions:
• List the City and its officers, officials, employees, and volunteers, as additional insureds
by endorsement with regard to operations, completed operations, and activities of or
on behalf of the named insured performed under contract with the City, with the
exception of the workers' compensation policy;
• Provide for an endorsement that the "other insurance" clause shall not apply to the City
of Corpus Christi where the City is an additional insured shown on the policy;
• Workers' compensation and employers' liability policies will provide a waiver of
subrogation in favor of the City; and
• Provide thirty (30) calendar days advance written notice directly to City of any,
cancellation, non-renewal, material change or termination in. coverage and not less
than ten (10) calendar days advance written notice for nonpayment of premium.
E. Within five (5) calendar days of a cancellation, non-renewal, material change or
termination of coverage, Contractor shall provide a replacement Certificate of
Insurance and applicable endorsements to City. City shall have the option to suspend
Contractor's performance should there be a lapse in coverage at any time during this
contract. Failure to provide and to maintain the required insurance shall constitute a
material breach of this contract.
Page 2 of 3
F. In addition to any other remedies the City may have upon Contractor's failure to provide
and maintain any insurance or policy endorsements to the extent and within the time
herein required, the City shall have the right to order Contractor to stop work hereunder,
and/or withhold any payment(s) which become due to Contractor hereunder until
Contractor demonstrates compliance with the requirements hereof.
G. Nothing herein contained shall be construed as limiting in any way the extent to which
Contractor may be held responsible for payments of damages to persons or property
resulting from Contractor's or its subcontractor's performance of the work covered
under this contract.
H. It is agreed that Contractor's insurance shall be deemed primary and non-contributory
with respect to any insurance or self insurance carried by the City of Corpus Christi for
liability arising out of operations under this contract.
It is understood and agreed that the insurance required is in addition to and separate
from any other obligation contained in this contract.
2016 Insurance Requirements
CCFD
Collections/Billing
12/07/2016 cg Risk Management
Bonds are not required for this service.
Page 3 of 3
Attachment D: Warranty Requirements
There is no warranty required under this service; the service
shall be performed as specified under Attachment A: Scope of
Work.
Page 1 of 1
Attachment E: Business Associate Agreement
This Privacy Agreement("Agreement") is effective upon signing this Agreement and is entered
into by and between City of Corpus Christi("City") and Contractor(the "Business Associate").
1. Term. This Agreement shall remain in effect for the duration of the Service Agreement the
Business Associate has with City for EMS billing and collections, and shall apply to all of
the Services provided by the Business Associate pursuant to this Agreement.
2. HIPAA Assurances. In the event Business Associate creates,receives, maintains, or
otherwise is exposed to personally identifiable or aggregate patient or other medical
information defmed as Protected Health Information("PHI") in the Health Insurance
Portability and Accountability Act of 1996 or its relevant regulations ("HIPAA") and otherwise
meets the definition of Business Associate as defmed in the HIPAA Privacy Standards (45
CFR Parts 160 and 164),Business Associate shall:
(a) Recognize that HITECH(the Health Information Technology for Economic and
Clinical Health Act of 2009) and the regulations thereunder(including 45 C.F.R.
Sections 164.308, 164.310, 164.312, and 164.316), apply to a business associate of the
City in the same manner that such sections apply to the City;
(b)Not use or further disclose the PHI, except as permitted by law;
(c)Not use or further disclose the PHI in a manner that had City done so,would violate
the requirements of HIPAA;
(d)Use appropriate safeguards (including implementing administrative,physical,
and technical safeguards for electronic PHI)to protect the confidentiality, integrity,
and availability of and to prevent the use or disclosure of the PHI other than as
provided for by this Agreement;
(e) Comply with each applicable requirements of 45 C.F.R. Part 162 if the
Business Associate conducts Standard Transactions for or on behalf of the City;
(f)Report promptly to the City any security incident or other use or disclosure of PHI
not provided for by this Agreement of which Business Associate becomes aware;
(g)Ensure that any subcontractors or agents who receive or are exposed to PHI
(whether in electronic or other format) are explained the Business Associate
obligations under this paragraph and agree to the same restrictions and conditions;
(h) Make available PHI in accordance with the individual's rights as required under
the HIPAA regulations;
(i)Account for PHI disclosures for up to the past six(6) years as requested
by City,which shall include:
(1)Dates of disclosure, (2) names of the entities or persons who received the
PHI, (3) a brief description of the PHI disclosed, and (4) a brief statement of
the purpose and basis of such disclosure;
Page 1 of 3
(j)Make its internal practices, books, and records that relate to the use and disclosure
of PHI available to the U.S. Secretary of Health and Human Services for purposes of
determining Customer's compliance with HIPAA; and
(k) Incorporate any amendments or corrections to PHI when notified by Customer
or enter into a Business Associate Agreement or other necessary Agreements to
comply with HIPAA.
3. Termination upon Breach of Provisions. Notwithstanding any other provision of this
Agreement, City may immediately terminate this Agreement and the Service Agreement if it
determines that Business Associate breaches any term in this Agreement. Alternatively, City
may give written notice to Business Associate in the event of a breach and give Business
Associate five(5)business days to cure such breach. City shall also have the option to
immediately stop all further disclosures of PHI to Business Associate if City reasonably
determines that Business Associate has breached its obligations under this Agreement. In the
event that termination of these Agreements is not feasible, Business Associate hereby
acknowledges that the City shall be required to report the breach to the Secretary of the U.S.
Department of Health and Human Services,notwithstanding any other provision of these
Agreements to the,contrary.
4. Return or Destruction of Protected Health Information upon Termination. Upon the
termination of this Agreement,unless otherwise directed by City,Business Associate shall
either return or destroy all PHI received from the City or created or received by Business
Associate on behalf of the City in which Business Associate maintains in any form. Business
Associate shall not retain any copies of such PHI.Notwithstanding the foregoing, in the event
that Business Associate determines that returning or destroying the Protected Health
Information is infeasible upon termination of this Agreement, Business Associate shall provide
to City notification of the condition that makes return or destruction infeasible. To the extent
that it is not feasible for Business Associate to return or destroy such PHI, the terms and
provisions of this Agreement shall survive such termination or expiration and such PHI shall be
used or disclosed solely as permitted by law for so long as Business Associate maintains such
Protected Health Information.
5.No Third Party Beneficiaries. The parties agree that the terms of this Agreement shall apply
only to themselves and are not for the benefit of any third party beneficiaries.
6.De-Identified Data.Notwithstanding the provisions of this Agreement, Business Associate
and its subcontractors may disclose non-personally identifiable information provided that the
disclosed information does not include a key or other mechanism that would enable the
information to be identified.
7.Amendment.Business Associate and City agree to amend this Agreement to the extent
necessary to allow either party to comply with the Privacy Standards, the Standards for
Electronic Transactions, the Security Standards, or other relevant state or federal laws or
regulations created or amended to protect the privacy of patient information.All such
amendments shall be made in a writing signed by both parties.
8.Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a meaning that
permits City to comply with the then most current version of HIPAA and the HIPAA privacy
regulations.
Page 2 of 3
s'
9. Definitions. Capitalized terms used in this Agreement shall have the meanings assigned to
them as outlined in HIPAA and its related regulations.
10. Survival. The obligations imposed by this Agreement shall survive any expiration or
termination of this Agreement.
CONTRACTOR
Signature: -
Printed Name: Ken Cooke
Title: President and COO
Date: April 5, 2017
AT
TEST: 'C--�1k. Ci- 41,k-(-Cf. tr,,,
REBECCA HUERTA
CITY SECRETARY
CITY OF CORPUS CHRISTI
Signature: YYleu .,
Printed Name: j'C\o-r. 'f?a-s►-r — _ L
Title: • f'a c..i-A-r . n.,..a..- (Y\9-s 9'142 ,�n ` .
Date: M • Z.O . t 7
�i
rt caw._
SF(RFTAQ
6
Approved as to legal form:
-0`I'rt.U' Pitt. C,
Buck Brice
Assistant City Attorney
For City Attorney
Page 3 of 3
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business.
2017-182490
Advanced Data Processing, Inc.,a subsidiary of Intermedix Corporation
Fort Lauderdale, FL United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 03/24/2017
being filed.
City of Corpus Christi(TX)a Texas Municipal Corporation Dat Ackn wledged: y
I
3 Provide the identification number used by the governmental entity or state agency to track or identify the ontra ,and provide a
description of the services,goods,or other property to be provided under the contract.
Contract#984
EMS billing,collection and related consulting services and equipment.
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
5 Check only if there is NO Interested Party. ❑
`%%►/IIIIIg�� x
6 AFFIDAVIT 0‘NoviA w
I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
•
•
• • STATE
Of
TIME •
• Signature of authorized agent of contracting business entity
"411AFFIX NOTARY SI WB
Sworn to and subscribed before me,by the said SVP and General Counsel ,this the 24th day of March
20 17 ,to certify which,witness my hand and seal of office.
/ ;- �, r j r Linda W. Smith Office Coordinator,Notary Public
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.883